2/26/2018 1 H. J. Kojian, Ph.D. FIVE ACRES © 2018 •About 11,500 miles •Pop. of about 3 mill. •Land locked •Genocide •Republic but 70 yrs of Soviet Domination
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H. J. Kojian, Ph.D.FIVE ACRES
© 2018
•About 11,500 miles•Pop. of about 3 mill.•Land locked•Genocide•Republic but 70 yrs of Soviet Domination
2/26/2018
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December 7, 1988 at 11:41 a.m.
6.9 Richter Scale
Another earthquake 5.8 four minutes later
Multiple After-shocks 5.0 magnitude for months
Lenninakan—Spitak—Kirovakan
25,000 deaths
19,000 injured
500,000 homeless
350 towns and villages were affected
58 completely destroyed
$16 Billion (US)
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December of 1989
Resilient 5
747 full
One month
PURPOSE
Direct Aid
Psychology Center in Kirovakan
Research
Prevalence Rate (2 to 87%)—Bosoglu et al., 2004.
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WAR ZONE
Infrastructure was devastated
Villages without utilities
Tents
Devastation
PSYCHOLOGICALLY
No knowledge/information of loved ones
Flat affect
General sense of depression and despair
Survival Mode
Anecdotal evidence for PTSD
People buried alive and bulldozed
Women and children rounded up in boxcars and shipped to Soviet Cities
No knowledge/information of loved ones
Dismemberment
Horror stories
Heroes
Life had not returned to normal
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EXPOSURE
Directly experiencing
Witnessing it as it occurs to others
Learning it occurred to family/friends
Experiencing repeated or extreme exposure to aversive details of the incident
Fear RESPONSE
Intrusive sxs
Dreams/nightmares
Flashbacks etc., “dissociative reactions”
“psychological distress”
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AGE(Bal and Jensen, 2007) 1999 Marmara earthquake
Turkey
Majority of research past 20 years focuses on adult PTSD
Developing countries generally have younger populations
Children and Adolescents tend to be the group most vulnerable to physical, social and psychological effects of natural disasters
Such events shatter child’s perception of world as a “safe and predictable” place
AGE 3-15% girls, 1 to 6% boys dx with PTSD (Hamblen, 2004)
Pynoos, 1998 (Armenia earthquake) PTSD incident rate of 70% even after 1 ½ yrs post event
40% to 70% PTSD 6 months > Athens Quake (Kolaitis et al., 1999)
Neuner (2006) 45% incident rate PTSD Indian Ocean tsunami
Bal and Jensen (2007) 71% of “young survivors” of Hurricane Floyd demonstrated symptoms of PTSD
AGE Sahin, et al., 2007
Psychological Symptoms in Children and Adolescents 1999 earthquakes in Turkey
Perceived Posttrauma Stress Symptoms Scale (PPTSS)
Arousal, Avoidance, Somatization—factor analyzed
Results showed, in general, earthquake had “very strong” impact on children and adolescents
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AGE Bodvarsdottir, et al., 2006
PTSD in children > earthquakes in Iceland
3 months > event
Child PTSD Reaction Index
33% of exposed group vs. 6% of control met PTSD criteria
“great horror,” ruminating thoughts about future earthquakes
Wish to be relocated (avoidance) and arousal sxs noted
Children not given crisis intervention reported “significantly higher” PTSD symptoms
Prior Pathology Prior pathology/traumatic experiences
Personality, parental and family factors, prior pathology, prior victimization (Green, et al., 1991)
Schizophrenics, bipolars vs normal controls > Northridge 1994 (Foy, et al., 2007)
Both patient groups reported higher Impact of Events Scale Scores
Schizophrenics decreased coping ability, self-esteem, and social support
Schizophrenics higher levels of avoidance
Schizophrenics respond differently than normal controls to stressful events
PROXIMITY Tale of Two Cities
Yerevan Residual problems No real PTSD Euthymic/unrestricted
Lenninakan (Gumry) Flattened affect Malaise Depression hopelessness
Goenjian, et al., 1995 Correlated high rates of PTSD and comorbid depression with
proximity to epicenter in Armenia earthquake
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PTSD Symptoms by Location(Sahin, et al., 2007)
Slight Moderate Epicenter
PPTSS 19.03* 29.87 34.52
Arousal 6.11 11.41 12.85
Avoidance 7.28 9.92 12.31
Somtiztion 5.64 8.53 9.36
School 4.93 7272 8.34
*means
Developing/Low Income Higher devastation in developing versus developed
countries (Kilic, et al., 2006)
6.9 Richter Scale
Republic but 70 yrs of Soviet Domination
Building Codes
Graft/Corruption
INTERVENTIONS
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Assessment Tools Posttrauma Stress Symptoms Scale (PPTSS)
Post-traumatic Stress Disorder Reaction Index for Children
Earthquake Experience Questionnaire
Traumatic Stress Symptoms Checklist
Impact of Events Scale
MMPI—2
PTSD SCALES—PS and PK
CHECK DSM—IV for CHILD REACTIONS
Identification
(Sahin, et al., 2007) negative school performance best predictor for the development of PTSD in all regions
“this is an interesting finding because it highlights the importance of schools [school based clinicians] after disasters”
Psychologists working in school settings
Identify children referred for decrease in academic/school functioning from baseline levels
Critical Incident Debriefing
Cognitive Restructuring
Systematic Desensitization
Psychiatric Intervention
Even just journaling without professional intervention was found to be helpful (STUDY?)
Treatment
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Shattering of one’s basic beliefs and assumptions about security
Trust
Safety
Meaning of life
Sense of invulnerability (denial can be a good thing)
Treatment
Attribution
Causal Beliefs (pessimistic explanatory style)—Massadand Hulsey, 2006. Event is …
GLOBAL—will affect every aspect of one’s life
STABLE—will last forever
INTERNAL Attribution—my own fault
Why God
Treatment
VICTIM to SURVIVOR
Victim SurvivorGlobal Limited
Stable Time Limited
Internal External Causation
Treatment
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RESILIENCY• People vary widely in their vulnerability for
developing PTSD
• Event + response
• Natural remission of symptoms
• Resilience
• Two main findings currently …
• Higher cognitive ability
• Strong social support
RESILIENCY• Bosoglu et al., (1994) studied political
prisoners who had been tortured for nearly four years and found 67% never developed PTSD!• Political dissidents and expected to be
tortured if arrested
• Higher intelligence
• Social support
• Emerged as heroes
RESILIENCYMcNally et al., 2003—9/11 tragedy. 9000 mental health
workers descended on NY assuming people would develop PTSD if they didn’t receive immediate intervention
• Trauma Centers were established (Project Liberty)
• Millions of dollars were allotted
• Nobody showed up for help
• 2.5 million pts expected, 643K utilized services
• $90 million in therapy funds remained unused
• NY-ers more resilient than thought, and relied on greater social support networks such as churches and others
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FURTHER RESEARCH Adult PTSD vs. child/adolescent reactions
Eren-Kocak et al., (2009) neurocognitive differences in PTSD diagnosed earthquake survivors (decreased attention, verbal memory, verbal fluency, and psychomotor speed).
Karakashian, 1994—professional vs. indigenous counselors who had, themselves, experienced the traumatic event
Najarian, et al., 2001 – effects of relocation after an earthquake
“Culture-Bound Stress Reactions” in Psychological Assessment of Adult Posttraumatic States by John Briere(1997)
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•Smyth, 1999•¾ of the US population has been exposed to “one or more life -threatening event” in their lifetime•Of those exposed ¼ develop “full-blown” PTSD (75 mill)
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Magnitude 4.4 Date-Time Tuesday, March 16, 2010 at 11:04:00
UTC Tuesday, March 16, 2010 at 04:04:00 AM at epicenter Time of Earthquake in oter Time Zones Location 33.992°N, 118.082°W Depth 18.9 km (11.7 miles) Region GREATER LOS ANGELES AREA, CALIFORNIA Distances 1 km (0 miles) ENE (62°) from Pico Rivera, CA 4 km (2 miles) SE (129°) from Montebello, CA 5 km (3 miles) SSW (212°) from Whittier Narrows Rec. Area, CA 8 km (5 miles) NE (37°) from Downey, CA 17 km (10 miles) ESE (115°) from Los Angeles Civic Center, CA Location Uncertainty horizontal +/- 0.3 km (0.2 miles); depth +/- 0.6 km (0.4 miles) Parameters Nph=177, Dmin=6 km, Rmss=0.39 sec, Gp= 22°, M-type=local magnitude (ML), Version=4 Source California Integrated Seismic Net: USGS Caltech CGS UCB UCSD UNR Event ID ci14601172
Illinois earthquake third to rattle upper Midwest since 1999
Wednesday's Illinois earthquake rated a 3.8 magnitude according to the US Geological Survey, and was the third mild temblor experienced in the region in recent years.
(Christian Science Monitor.com)